Are depression and anxiety determinants or indicators of quality of life in breast cancer patients?

Depression and anxiety are associated with a decline of health-related quality of life (QoL) in breast cancer patients, and the present study aims to investigate the longitudinal relationship of depression and anxiety with QoL in breast cancer patients. Depression and anxiety (HADS) as well as QoL (EORTC QLQ-C30) were assessed at baseline and six-month follow-up in 118 breast cancer patients and analysed using cross-lagged partial correlation analysis (CLPC). There were significant partial correlations between depression and anxiety at baseline and physical functioning, emotional functioning and "global health and QoL" at six-month follow-up (range of pr = -0.197 and -0.392; p < 0.05). "Global health and QoL" at baseline was significantly correlated with depression and anxiety at follow-up (pr = -0.207 and -0.327; p < 0.05). Cognitive functioning at baseline was significantly associated with anxiety at follow-up (pr = -0.248; p < 0.01). CLPC analysis of two models (depression and anxiety determining QoL vs. QoL determining depression and anxiety) did not show significant results. Hence, in breast cancer patients, depression and anxiety are closely related to QoL and the observed correlations suggest a complex interrelation in which depression and anxiety have to be regarded as indicators of QoL rather than determinants.

Family caregivers: gender differences in adjustment to stroke survivors' mental changes.

OBJECTIVES: This prospective longitudinal study investigated gender differences in caregiving spouses' adjustment to the challenges of a poststroke life situation based on the caregiving stress model of Yee and Schulz (2000), which we modified. METHOD: The sample consisted of 97 stroke-survivor and spouse dyads who were questioned 3 months after stroke and again 1 year later. The Beck Anxiety Inventory (Beck & Steer, 1997), the Beck Depression Inventory (Beck, Steer, & Garbin, 1988), and the Giessen Complaints List (Brähler & Scheer, 1995) were used to capture mental health and physical complaints in stroke survivors' spouses. Covariance analytical methods (analysis of covariance; ANCOVA) were conducted on data from both measuring times to test gender-related interaction effects. RESULTS: Generally, women caregivers reported more anxiety and depressive symptoms than did their men counterparts. However, 15 months after stroke onset, in cases where individuals with stroke had substantial cognitive and mental impairments, the opposite appeared to be true. The results supported the modified caregiving stress model. Women spousal caregivers seem to adjust better to cognitive and emotional changes in their partners than did caregiving husbands. CONCLUSIONS: The rehabilitation of stroke survivors may be more successful if gender differences in caregivers' adaptation to their partners' mental changes are taken into consideration in intervention programs for families of stroke survivors. Men spousal caregivers may need counseling aimed at supporting their adjustment to stroke-related cognitive and emotional changes in their wives.